(The article below was written by Clinical Lead Dr Georgina Brown in response to the Neurodivergence in Scotland by The Equalities, Human Rights and Civil Justice Committee)
I welcome the Committee’s recognition of the challenges facing neurodivergent people in Scotland. But the central issue is clear: private diagnosis is not the problem. The failure to provide timely, equitable NHS assessment and treatment is the problem.
No one should have to pay privately for ADHD or autism assessment. In an ideal system, everyone would access high-quality NHS assessment within a reasonable timeframe. That is not the reality. Patients are waiting years, deteriorating while they wait, and in some areas there is no meaningful pathway.
Many people seek private assessment not to “jump the queue”, but because the queue is clinically unsafe. Adults often present after decades of misdiagnosis, burnout, anxiety, depression and instability. Parents seek help because they can see their child struggling while services remain inaccessible.
The system punishes patients twice: first by making them wait intolerably long for diagnosis, then by refusing shared care when they seek private help out of necessity. Patients who have been properly assessed, titrated, stabilised and monitored may still be left paying privately for medication that would otherwise be available through NHS prescribing. Some stop effective treatment because they cannot afford it. That is unsafe, unfair and avoidable.
Quality assurance matters. Poor-quality assessments, whether NHS or private, should not be accepted. But high-quality assessments, wherever completed, should be recognised. Scotland needs national ADHD and autism assessment standards. The standard should matter more than where the assessment took place.
ADHD and autism must also be understood properly. They are lifelong neurodevelopmental conditions; they do not originate in mental illness. Yet ADHD diagnosis and treatment remain too often trapped behind psychiatric or mental health gatekeeping. That is outdated, stigmatising and clinically wrong. Psychiatry has an important role in complexity, comorbidity and risk, but it should not be the default gateway for routine assessment.
GPs with extended roles, specialist nurses, pharmacists, psychologists, occupational therapists and other trained clinicians can contribute to diagnosis, treatment, monitoring and holistic care. Scotland needs dedicated neurodevelopmental services, not overstretched psychiatric pathways being asked to absorb demand they cannot manage alone.
ADHD is not a minor behavioural issue. It is associated with morbidity, mortality risk, obesity, cardiovascular risk, hormonal fluctuation, emotional dysregulation, accidents, substance misuse, educational disadvantage and occupational instability. For girls and women, hormonal changes across puberty, menstruation, pregnancy, perimenopause and menopause can significantly affect symptoms and treatment response.
The answer is not to dismiss private diagnosis, nor to keep ADHD locked inside mental health services. The answer is a modern, holistic neurodevelopmental model: national standards, shared care, physical monitoring, multidisciplinary expertise, post-diagnostic support, and recognition of high-quality care wherever it is delivered.
